Lower extremity blocks for analgesia

Abstract

A large proportion of patients undergoing surgery do not receive adequate postoperative analgesia.1 Postoperative pain is the leading cause of unplanned hospital admissions after ambulatory surgery and a major source of dissatisfaction with perioperative outcome.2 The establishment of acute pain services in major institutions both in the United States and overseas has had a major effect on postoperative comfort and patient satisfaction.3,4 Most acute pain services primarily use intravenous patient-controlled analgesia (PCA) or patient-controlled epidural infusion; however, advances in neuronal blockade offer an unprecedented range of effective and surgery site–specific analgesic options. Using long-acting local anesthetics, peripheral nerve blocks can be used to provide an excellent anesthesia and postoperative analgesia. Additionally, a catheter for continuous infusion of local anesthetics can be inserted perineurally to extend the analgesia beyond the duration of the single-shot blocks. This review will discuss the advantages and limitations of various nerve block techniques when used for postoperative pain management for several common surgical indications. Copyright 2002, Elsevier Science (USA). All rights reserved.